CMS Uses Aggressive Goal-setting to Drive Improvement

Officials for CMS' Partnership for Patients describe how to create systems of change using quantifiable targets.

CHICAGO — Much of the success of the CMS-coordinated Partnership for Patients quality initiative is tied to its widespread use of goal-setting, agency officials said during a talk at the American College of Healthcare Executives 2015 Congress on Healthcare Leadership.

Goal-setting leads to the creation of systems to meet those goals, and participants in the Partnership for Patients program are doing that, said Dennis Wagner, co-director of the Partnership for Patients and the Transforming Clinical Practice Initiative. "Goals are empowering," Wagner said.

There have been plenty of individual success stories resulting from the Partnership for Patients, with much of that taking place in Hospital Engagement Networks. Looking more broadly, the number of patient harms relative to discharges is on a downward trajectory, falling to 121 per 1,000 discharges in 2013 from 145 in 2010, with much of that change taking place once the Partnership for Patients efforts were in full effect, in 2012. Early signs indicate the number will fall again in 2014.

The partnership's other co-director, Paul McGann, M.D., said that the partnerships' aggressive goal-setting approach took some getting used to at the historically staid CMS. Government goal setting traditionally involves marginal changes in the neighborhood of low single-digit percentage increases, he said. McGann said that when the Partnership for Patients released its broad goals of reducing preventable hospital-acquired conditions by 40 percent and reducing 30-day readmissions by 20 percent over four years, people laughed, thinking it was a joke.

"It's not common to get these kinds of goals," Wagner said. But when people learned that the goals were based on the results of best-in-class performers, they took the goals more seriously. "It's been shown you can do this, so we're going to do this everywhere," Wagner said.

Wagner also noted that that was the philosophy behind HHS Secretary Sylvia Burwell's setting of goals for use of value-linked health care reimbursement in Medicare.

"Big changes are happening," McGann said. "We think the health care system is starting to turn."

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